Administrative Burdens Limit Psychologists’ Capacity to Address Ongoing Mental Health Needs
Although demand for mental health treatment remains high, several administrative barriers faced by psychologists are making it more difficult for patients to access the care they need. As a result of those barriers and other factors, more than half of psychologists say they do not have any openings for new patients and that symptom severity among patients has increased.
These were among the findings of the American Psychological Association’s (APA’s) 2024 Practitioner Pulse Survey titled “Barriers to Care in a Changing Practice Environment,” which found that certain insurance hurdles not only hurt psychology practices, they hurt the patients who need care the most.
Lynn Bufka
“The report substantiated what we’ve been hearing anecdotally from our members across all practice settings,” said Lynn Bufka, PhD, ABPP, Head of Practice, American Psychological Association, the leading scientific and professional organization representing psychology in the United Sates. “From large health systems to community clinics and independent practices, the hurdles providers need to overcome to be properly reimbursed for mental health services prevent many from participating in insurance networks. This, in turn, places more financial burden on patients and limits the set of potential psychologists they have available to them.”
Practitioner Pulse Survey Highlights
The APA Practitioner Pulse Survey series has been conducted annually since 2020. Originally intended to track changes in psychological practice during the COVID-19 public health emergency, the survey has since been revised to track changes in the workforce after the emergency expired in May 2023.
This most recent survey found that:
- A third (34%) of psychologists do not accept any form of health insurance.
- Under half (48%) had participated in insurance networks in the past.
- Only 18% had never participated with insurance in their careers.
Among psychologists who quit insurance networks or never participated with insurance:
- More than 8 in 10 (82%) said that insufficient reimbursement rates were a primary obstacle to taking insurance.
- 62% reported administrative challenges, such as pre-authorization requirements and audits as barriers to their participation.
- More than half (52%) pointed to concerns about payment reliability, including delays in payment and refund demands as barriers.
“Psychologists in independent practice are especially burdened by these obstacles,” Dr. Bufka said. “Managing the many administrative challenges eats into the time they can devote to direct patient care.”
Telehealth Services May Offer Relief to Both Psychologists and Their Patients
According to Dr. Bufka, APA is advocating for changes in insurance reimbursement structures and is working to help payers understand the impacts of administrative challenges on providers, encouraging them to streamline processes and make it easier for providers to participate in insurance programs.
She pointed to telehealth as another strategy that may make a difference.
“We know that telehealth is an efficient and effective way to deliver care, and patients have expressed a desire for this option,” she said. “Thanks to PSYPACT, providers in about 40 states can practice across state boundaries via telepsychology and in-person, face-to-face on a temporary basis. This can help patients – especially those in rural or underserved areas – access a provider with a specific set of expertise relevant to their mental health condition.”
Psychology as a Multi-Tiered Profession
Telehealth capabilities do not change the overall number of providers available in the US, however. That’s why Dr. Bufka said it is critical to increase the number of people pursuing psychology as a career.
“Ideally, the United States would have a system with a sufficient number of providers who can get people into psychological care at an earlier stage, with more preventive and early-intervention services,” she said. “These early intervention strategies can help patients develop the preliminary skills they need to handle minor concerns on their own before they turn into major concerns.”
APA is addressing this issue through various initiatives, including those that advocate for payment and education models that support partnerships between psychologists and primary care. For example, a psychology professional on-site in a primary care clinic could provide patients with those initial coping strategies and a “warm hand off” to a specialist for follow up. Dr. Bufka says this model is already working successfully in pediatric clinics.
“We encourage our members to develop their local networks, form relationships with primary care providers, and work closely together on early intervention strategies,” she said.
To further help meet patient demand for mental health services, APA is working to create a blueprint for psychology to become a profession that embraces and guides the training of master’s degree-level professionals.
All states offer licensure for master’s degreed clinicians in social work, counseling, and marriage and family therapy. But only 20 states offer licensures to master’s-level psychology graduates, and the scope of practice, educational requirements, and level of independence varies from state to state. Some states require master’s-level psychology professionals to be supervised throughout their careers, while others grant independence after a certain number of hours or years of supervision. The titles given upon licensure also vary by state, and include licensed psychological associate (LPA), licensed psychological practitioner (LPP), licensed psychological examiner (LPE), and master’s limited license (MLL).
“As early as 2018, APA set up a process to begin accrediting master’s degree programs in what we call ‘health service psychology,’ which is the track of psychology that delivers direct health care services as opposed to working in a lab or research,” Dr. Bufka said, noting that programs are starting to seek this accreditation.
She added that this new professional category will offer opportunities to those interested in a career in psychology, but who cannot commit to a longer-term, higher-cost traditional doctoral program. Moreover, she said that colleges and universities may find that developing a master’s degree-level program is easier to implement than a doctoral program, potentially creating opportunities at learning institutions geographically disparate from the coastal areas and city centers where most legacy institutions are located.
“If psychology professionals are being educated, trained, making professional connections, and starting their careers in rural or underserved regions, it stands to reason that some will stay in these locations as they continue their career,” Dr. Bufka said. “We hope that workforce development initiatives like this and others starting as early as high school will help more people find pathways to the field of psychology, which in turn will help bolster the number of professionals available to help address the mental health crisis in America.”
